Hospital Charity Care: How It Works and Why It Matters

Zachary Levinson, Scott Hulver, and Tricia Neuman
Published: Nov 03, 2022

About four in ten adults (41%) in the United States—and about six in ten (57%) of those with household incomes below $40,000—have some level of medical debt, owing an estimated $195 billion or more in total. Many adults who report medical debt cite costs associated with emergency care (50%) and hospitalizations (35%) as sources of unpaid bills. Affording this care may be especially challenging for the large number of adults who are uninsured or underinsured. The financial impact of unpaid bills from hospitals and other providers on patients and their families can be substantial and long lasting. Recent reporting indicates that hospitals are earning healthy margins in some regions where a large share of residents are burdened with medical debt. In response to concerns about medical debt and the affordability of care more generally, policymakers have explored options to strengthen the regulation of hospital charity care programs, which provide free or discounted services to eligible patients who are unable to afford their care.

Is there financial help for my medical bills?

Financial assistance programs, sometimes called “charity care,” provide free or discounted health care to people who need help paying their medical bills. These programs may help patients who do not have insurance and patients who have insurance but are underinsured. These programs may be provided by your medical care provider and your state. Additionally, there may be non-profit organizations or advocacy groups that can help you.

The Affordable Care Act (ACA) requires hospitals with 501(c)(3) nonprofit status to provide this free or discounted care

. Hospitals are required to have a written Financial Assistance Policy (FAP) and a written Emergency Medical Care policy. These policies should be widely publicized (for example, a conspicuous written notice on billing statements and public displays) and must include specific information such as:

Eligibility criteria for financial assistance and whether the care is free or discounted
Basis for calculating amounts that you are charged
How you apply

As part of the hospital intake or discharge process, the hospital must offer you a paper copy of the plain language summary of the FAP. This summary must include:

A brief description of the eligibility requirements and assistance offered under the FAP.
A brief summary of how to apply for assistance under the FAP.
The direct website address (or URL) and physical locations where the individual can obtain copies of the FAP and FAP application form.
Instructions on how the individual can obtain a free copy of the FAP and FAP application form by mail.

Steps to ask about financial assistance or charity care

Ask for a copy of the hospital’s FAP up front. By law, the policy must be provided free of charge and explain how to apply for help. In communities with significant limited English proficiency populations, a hospital may be required to translate documents into the primary language of those communities.
Fill out an application form. You may need to provide information about your income, including last year’s tax forms or a current pay stub, and your expenses, including your rent or mortgage payment, utilities, credit cards, and other expenses.
Ask your provider how long it takes to process your application for financial assistance, how to get answers to questions about the application, and what happens with your bill in the meantime.
Notify any debt collectors that you’re seeking financial assistance for the bill and tell them to pause collections while that process plays out—and if they already reported it on your credit, to show the bill as disputed.
Follow up with your provider about the status of your application as necessary.

The IRS provides more information about charity care or financial assistance policies here

. And remember, in exchange for the nonprofit hospital being treated favorably under federal tax laws, they are required to follow the requirements of these programs. If you suspect the hospital is NOT following these requirements, notify the IRS

Even if a hospital is for-profit or private, they may have a financial assistance policy that can help you pay your medical bills. Ask your hospital for information about their FAP, including the eligibility requirements and how you can apply.

Some states have charity care laws that require hospitals to provide free or discounted care to patients meeting eligibility criteria. This eligibility determination can be based on income. Here are some of the states that provide protections:

California, Connecticut, Illinois, Maine, Maryland, Nevada, New Jersey, New York, Rhode Island, and Washington have protections that apply to all hospitals.
Louisiana, Oregon, and Texas have protections that apply only to nonprofit or state hospitals.
Colorado, Massachusetts, and South Carolina have state-run financial assistance programs.

Even if your medical bill is in collection or you have been sued for the debt, you may still want to apply for charity care or financial assistance. You can also request that the debt collector stop collection activity while your application is pending with the hospital. Here is a sample letter

that you can use or modify to send to the debt collector. Telling the debt collector to stop contacting you does not stop the debt collector or the hospital from using other legal ways to collect the debt from you if you owe it.